健脾通络汤治疗慢性阻塞性肺疾病合并抑郁症的效果研究

严飞飞; 徐旭东; 张海波; 姬亚锋

doi:10.16766/j.cnki.issn.1674-4152.002560

健脾通络汤治疗慢性阻塞性肺疾病合并抑郁症的效果研究

doi: 10.16766/j.cnki.issn.1674-4152.002560

1.
浙江普陀医院呼吸与危重症医学科，浙江舟山 316100
2.
湖州市中心医院骨科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2018ZD045

舟山市科技计划项目 2020C31086

详细信息

通讯作者:
严飞飞, E-mail: yff0202020@126.com

中图分类号: R563 R289.5
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- 文章访问数: 174
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- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-25
- 网络出版日期: 2022-09-23

Effects of Jianpi Tongluo Decoction on chronic obstructive pulmonary disease complicated with depression

1.
Respiratory and Intensive Care Unit, Putuo Hospital of Zhejiang, Zhoushan, Zhejiang 316100, China

摘要

摘要: 目的观察健脾通络汤对慢性阻塞性肺疾病合并抑郁症(肺脾气虚痰瘀阻肺证)患者呼吸道症状、肺通气功能及心理状态的影响。方法采用随机数字表法将浙江普陀医院呼吸与危重症医学科2019年9月—2020年9月收治的84例慢性阻塞性肺疾病合并抑郁症患者分为观察组(42例)和对照组(42例)，对照组给予祛痰、解痉等常规西药治疗，观察组在对照组基础上联合健脾通络汤治疗，2组1个疗程均为4周，共治疗3个疗程。比较治疗前后2组呼吸道症状、CAT评分、BODE指数评分、HAMD评分、SDS评分及肺通气功能指标(FEV₁、FEV₁/FVC、MIP、MEP)的改善状况，并评估2组临床疗效及不良反应。结果观察组和对照组总有效率分别为92.86%、76.19%，观察组明显高于对照组(P＜0.05)；治疗后，观察组呼吸道症状积分、CAT评分和BODE指数评分，SDS评分和HAMD评分均明显低于对照组(均P＜0.05)，FEV₁、FEV₁/FVC、MIP、MEP水平均明显高于对照组(均P＜0.05)；2组均无明显不良反应。结论健脾通络汤能够改善慢性阻塞性肺疾病合并抑郁症患者肺通气功能，缓解呼吸道症状，改善患者抑郁状态。
- 健脾通络汤 /
- 慢性阻塞性肺疾病 /
- 抑郁症 /
- 肺脾气虚痰瘀阻肺证 /
- 呼吸道症状 /
- 肺通气功能 /
- 抑郁状态
Abstract: Objective To observe the effect of Jianpi Tongluo Decoction on the respiratory symptoms, pulmonary ventilation function and psychological state of patients with chronic obstructive pulmonary disease complicated with depression (Fipi Qixu Tanyu Zufei syndrome). Methods A total of 84 patients with chronic obstructive pulmonary disease complicated with depression treated in the Department of Respiratory and Critical Care Medicine of Putuo Hospital from September 2019 to September 2020 were randomly divided into observation group and control group, with 42 patients in each group. The control group was treated with conventional Western medicine, such as expectorant and antispasmodic, and the observation group was treated with Jianpi Tongluo Decoction on the basis of the control group. One course of treatment in both groups was 4 weeks, with a total of three courses of treatment. The respiratory symptoms, CAT, BODE index, HAMD, SDS and pulmonary ventilation function index (FEV₁, FEV₁/FVC, MIP and MEP) scores were compared. The clinical efficacy and adverse reactions of the two groups were evaluated. Results The total effective rates of the observation and control groups were 92.86% and 76.19%, respectively. The observation group had a significantly higher rate than the control group (P < 0.05). After treatment, the respiratory symptoms, CAT, BODE index, SDS and HAMD scores of the observation group were significantly lower than those of the control group (all P < 0.05). Meanwhile, the FEV₁, FEV₁/FVC, MEP and MIP index levels of the observation group were significantly higher than those of the control group (all P < 0.05). No obvious adverse reactions were observed in both groups. Conclusion The application of Jianpi Tongluo Decoction could improve pulmonary ventilation function, alleviate respiratory symptoms and improve depression in patients with chronic obstructive pulmonary disease complicated with depression.
- Jianpi Tongluo Decoction /
- Chronic obstructive pulmonary disease /
- Depression /
- Fipi Qixu Tanyu Zufei syndrome /
- Respiratory symptoms /
- Pulmonary ventilation function /
- Depressive state

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表 1 2组COPD合并抑郁症患者临床疗效比较[例(%)]

Table 1. Comparison of clinical efficacy between two groups of COPD patients with depression[cases(%)]

组别	例数	治愈	显效	有效	无效	总有效
对照组	42	6(14.29)	11(26.19)	15(35.71)	10(23.81)	32(76.19)
观察组	42	11(26.19)	20(47.62)	8(19.05)	3(7.14)	39(92.86)
注：2组总有效率比较，χ²=4.459, P=0.035；2组疗效比较，Z=2.107，P=0.001。

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表 2 2组COPD合并抑郁症患者呼吸道症状积分比较(x ±s，分)

Table 2. Comparison of respiratory symptom scores between two groups of COPD patients with depression

组别	例数	咳嗽		咳痰		喘息		呼吸困难
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	42	2.23±0.38	1.38±0.26^a	2.19±0.36	1.27±0.24^a	2.15±0.40	1.16±0.19^a	1.85±0.32	0.97±0.15^a
观察组	42	2.15±0.45	0.76±0.12^a	2.32±0.41	0.63±0.08^a	2.09±0.34	0.65±0.09^a	1.93±0.28	0.49±0.07^a
t值		0.880	14.032	1.544	16.395	0.741	15.721	1.219	18.793
P值		0.381	＜0.001	0.126	＜0.001	0.461	＜0.001	0.226	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组COPD合并抑郁症患者CAT评分和BODE指数评分比较(x ±s，分)

Table 3. Comparison of cat scores and BODE index scores of COPD patients with depression in two groups

组别	例数	CAT评分		BODE指数评分
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	42	22.13±3.31	16.18±2.86^a	6.19±0.83	5.64±0.70^a
观察组	42	21.94±3.15	12.76±2.49^a	6.31±0.75	4.89±0.64^a
t值		0.269	5.845	0.695	5.125
P值		0.789	＜0.001	0.489	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 4 2组COPD合并抑郁症患者抑郁状态评分比较(x ±s，分)

Table 4. Comparison of depression scores of COPD patients with depression between the two groups

组别	例数	HAMD评分		SDS评分
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	42	28.33±4.17	22.46±3.66^a	63.19±7.63	56.78±6.09^a
观察组	42	28.62±3.95	17.81±3.11^a	62.89±7.16	51.29±5.35^a
t值		0.327	6.274	0.186	4.389
P值		0.744	＜0.001	0.853	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 5 2组COPD合并抑郁症患者肺通气功能比较(x ±s)

Table 5. Comparison of pulmonary ventilation function between two groups of COPD patients with depressio

组别	例数	FEV₁(L)		FEV₁/FVC(%)		MIP(cm H₂O)		MEP(cm H₂O)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	42	1.51±0.24	1.62±0.31^a	50.19±6.46	54.37±6.92^a	56.21±7.15	72.51±8.68^a	92.31±11.21	97.54±12.15^a
观察组	42	1.49±0.28	1.83±0.35^a	49.75±6.53	58.38±7.23^a	55.94±7.32	81.16±10.33^a	93.15±10.85	109.27±14.07^a
t值		0.351	2.911	0.310	2.597	0.171	4.155	0.349	4.089
P值		0.726	0.005	0.757	0.011	0.865	＜0.001	0.728	＜0.001
注：与同组治疗前比较，^aP＜0.05。1 cm H₂O=0.098 kPa。

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参考文献(19)

[1]	梁桂林, 罗毅, 王彬, 等. 固本宣肺汤治疗稳定期慢性阻塞性肺疾病疗效及对免疫功能的影响[J]. 中华中医药学刊, 2020, 38(8): 183-186. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202008044.htm LIANG G L, LUO Y, WANG B, et al. Clinical Efficacy of Guben Xuanfei Decoction in Treatment of Stable Chronic Obstructive Pulmonary Disease and Its Effect on Immune Function[J]. Chinese Archives of Traditional Chinese Medicine, 2020, 38(8): 183-186. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202008044.htm
[2]	黄莹, 黄进, 董子青, 等. 桑菊清解汤治疗痰热蕴肺型慢性阻塞性肺疾病临床疗效及对免疫功能影响[J]. 中华中医药学刊, 2021, 39(7): 184-187. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202107047.htm HUANG Y, HUANG J, DONG Z Q, et al. Effect of Sangju Qingjie Decoction on Chronic Obstructive Pulmonary Disease with Phlegm-Heat Accumulation and Its Influence on Immune Function[J]. Chinese Archives of Traditional Chinese Medicine, 2021, 39(7): 184-187. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202107047.htm
[3]	李阳, 霍建民. 慢性阻塞性肺疾病合并症的发病率及预后研究进展[J]. 临床肺科杂志, 2018, 23(8): 1527-1531. doi: 10.3969/j.issn.1009-6663.2018.08.045 LI Y, HUO J M. Research Progress on incidence rate and prognosis of chronic obstructive pulmonary disease[J]. Journal of Clinical Pulmonary Medicine, 2018, 23(8): 1527-1531. doi: 10.3969/j.issn.1009-6663.2018.08.045
[4]	陈学昂, 王明航, 李素云, 等. 肝调畅情志与慢性阻塞性肺疾病合并焦虑抑郁的相关性研究[J]. 中华中医药学刊, 2017, 35(5): 1196-1198. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201705039.htm CHEN X A, WANG M H, LI S Y, et al. Research On Correlation of Liver Regulating Emotion and COPD with Anxiety Depression[J]. Chinese Archives of Traditional Chinese Medicine, 2017, 35(5): 1196-1198. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201705039.htm
[5]	王晓娟, 方向阳. 慢性阻塞性肺疾病全球倡议2019: 慢性阻塞性肺疾病诊断、治疗与预防全球策略解读[J]. 中国全科医学, 2019, 22(18): 2141-2149. doi: 10.12114/j.issn.1007-9572.2019.00.064 WANG X J, FANG X Y. Interpretation of the Global Strategy for the Diagnosis, Management, and Prevention of COPD 2019 by GOLD[J]. Chinese General Practice, 2019, 22(18): 2141-2149. doi: 10.12114/j.issn.1007-9572.2019.00.064
[6]	中华医学会精神科分会. 中国精神障碍分类与诊断标准(CCMD-3)[M]. 3版. 济南: 山东科学技术出版社, 2001: 83-84, 87-89. Psychiatric branch of Chinese Medical Association. Chinese classification and diagnostic criteria for mental disorders (CCMD-3)[M]. Version 3 Jinan: Shandong science and Technology Press, , 2001: 83-84, 87-89.
[7]	汤毓华, 张明园. 汉密顿抑郁量表(HAMD)[J]. 上海精神医学, 1984(2): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402003.htm TANG Y H, ZHANG M T. Hamilton Depression Scale (HAMD)[J]. Shanghai Psychiatry, 1984(2): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402003.htm
[8]	郑筱萸. 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002: 54-58. ZHENG X Y. Guiding principles for clinical research of new Chinese medicine[M]. Beijing: China Medical Science and Technology Press, 2002: 54-58
[9]	舒良. 自评抑郁量表[J]. 中国心理卫生杂志, 1999(增刊): 194-196. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJS202112006.htm SHU L. Self rating Depression Scale[J]. Chinese Journal of Mental Health, 1999(Supplemen): 194-196. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJS202112006.htm
[10]	张明园. 精神科评定量表手册[M]. 长沙: 湖南科学技术出版社, 1993: 39-42. ZHANG M Y. Handbook of psychiatric assessment scale[M]. Changsha: Hunan Science and Technology Press, 1993: 39-42.
[11]	闫香桂, 吴国芳, 黄芬, 等. 中医药治疗稳定期慢性阻塞性肺疾病研究进展[J]. 中医学报, 2016, 31(9): 1284-1288. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201609011.htm YAN X G, WU G F, HUANG F, et al. Progress of TCM Treatment of Chronic Obstructive Pulmonary Disease in Stable Phase[J]. China Journal of Chinese Medicine, 2016, 31(9): 1284-1288. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201609011.htm
[12]	吴娇, 王聪. 黄芪的化学成分及药理作用研究进展[J]. 新乡医学院学报, 2018, 35(9): 755-760. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX201809002.htm WU J, WANG C. Research Progress on chemical constituents and pharmacological effects of Astragalus membranaceus[J]. Journal of Xinxiang Medical University, 2018, 35(9): 755-760. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX201809002.htm
[13]	张晓娟, 左冬冬. 白术化学成分及药理作用研究新进展[J]. 中医药信息, 2018, 35(6): 101-106. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN201806025.htm HANG X J, ZUO D D. New progress in chemical constituents and pharmacological effects of Atractylodes macrocephala[J]. Information on Traditional Chinese Medicine, 2018, 35(6): 101-106. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN201806025.htm
[14]	陈梦雨, 刘伟, 侴桂新, 等. 山药化学成分与药理活性研究进展[J]. 中医药学报, 2020, 48(2): 62-66. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXB202002016.htm CHEN M Y, LIU W, CHOU G X, et al. Research Progress on chemical constituents and pharmacological activities of Chinese yam[J]. Journal of Traditional Chinese Medicine, 2020, 48(2): 62-66. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXB202002016.htm
[15]	邓亚羚, 任洪民, 叶先文, 等. 桔梗的炮制历史沿革、化学成分及药理作用研究进展[J]. 中国实验方剂学杂志, 2020, 26(2): 190-202. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202002030.htm DENG Y L, REN H M, YE X W, et al. Progress of Historical Evolution of Processing, Chemical Composition and Pharmacological Effect of Platycodonis Radix[J]. Chinese Journal of Experimental Traditional Medical Formulae, 2020, 26(2): 190-202. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202002030.htm
[16]	和焕香, 郭庆梅. 瓜蒌化学成分和药理作用研究进展及质量标志物预测分析[J]. 中草药, 2019, 50(19): 4808-4820. doi: 10.7501/j.issn.0253-2670.2019.19.032 HE H X, GUO Q M. Research Progress on chemical constituents and pharmacological effects of Trichosanthes Trichosanthes and prediction and analysis of quality markers[J]. Chinese Traditional and Herbal Drugs, 2019, 50(19): 4808-4820. doi: 10.7501/j.issn.0253-2670.2019.19.032
[17]	卓小玉, 陈晶, 田明, 等. 麻黄的化学成分与药理作用研究进展[J]. 中医药信息, 2021, 38(2): 80-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN202102017.htm ZHUO X Y, CHEN J, TIAN M, et al. Research Progress on Chemical Constituents and Pharmacological Effects of Ephedra sinica[J]. Information on Traditional Chinese Medicine, 2021, 38(2): 80-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN202102017.htm
[18]	唐照琦, 李彪, 王秋红, 等. 胆南星的化学成分、药理作用及相关复方临床应用的研究进展[J]. 中国药房, 2020, 31(12): 1523-1527. doi: 10.6039/j.issn.1001-0408.2020.12.21 TANG Z Q, LI B, WANG Q H, et al. Research Progress on chemical constituents, pharmacological effects and clinical application of related compounds of dannanxing[J]. China Pharmacy, 2020, 31(12): 1523-1527. doi: 10.6039/j.issn.1001-0408.2020.12.21
[19]	祁玉凤, 邵强, 沈兵. 慢性阻塞性肺疾病患者CAT评分与肺功能及血气分析等指标的相关性分析[J]. 中华全科医学, 2021, 19(9): 1504-1506. doi: 10.16766/j.cnki.issn.1674-4152.002097 QI Y F, SHAO Q, SHEN B. Correlation analysis of CAT score with lung function and blood gas analysis in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of General Practice, 2021, 19(9): 1504-1506. doi: 10.16766/j.cnki.issn.1674-4152.002097